Provider Demographics
NPI:1952350977
Name:CHARLOTTE ORTHOPAEDIC CLINIC PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:CHARLOTTE ORTHOPAEDIC CLINIC PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-625-0984
Mailing Address - Street 1:4161 TAMIAMI TRL
Mailing Address - Street 2:UNIT 101
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9204
Mailing Address - Country:US
Mailing Address - Phone:941-625-0984
Mailing Address - Fax:941-625-0877
Practice Address - Street 1:4161 TAMIAMI TRL
Practice Address - Street 2:UNIT 101
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-625-0984
Practice Address - Fax:941-625-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0886990001OtherPALMETTO
FL4639456OtherAETNA
FL1596302000OtherDEPT OF LABOR
FL77674OtherBLUE CROSS BLUE SHIELD
FLDE0219OtherRAILROAD MEDICARE
FLDE0219OtherRR MEDICARE
FL7323528-002OtherCIGNA-PAL
FLK2675OtherMEDICARE
FLDE0219OtherRR MEDICARE
FL1596302000OtherDEPT OF LABOR
FL0886990001Medicare NSC